Women Are Posing as Men to Buy Testosterone: What Menopause Testosterone Really Does — and What It Doesn’t

Key takeaways

The uncomfortable paradox behind the headline

A woman experiencing persistent loss of sexual desire asks whether testosterone might help. Her GP declines, yet online discussions promise energy, confidence and a restored sense of self. A male-health website appears willing to supply the hormone only if she presents herself as male. That is the access paradox reported by BBC Wales in September 2026.

The story is not simply about women breaking rules. It concerns inconsistent access to a legitimate treatment, confusing public messages about what that treatment can do, and the danger created when a female clinical pathway is replaced by a male one. Dismissal and overpromotion can push in the same unsafe direction.

Women should not have to pretend to be men to discuss a hormone their bodies naturally produce. Better access, however, cannot mean easier access to male-pattern exposure without assessment. The answer lies between two slogans: testosterone is neither forbidden nor a universal answer to menopause.

Testosterone is a female hormone too

Premenopausal women produce testosterone and related androgens through the ovaries and adrenal glands, as well as through conversion in other tissues. The hormone contributes to female physiology, including sexual anatomy and behaviour. Calling it exclusively male is biologically inaccurate and can make a reasonable clinical conversation sound taboo.

Circulating concentrations generally change with age, and surgical or medical loss of ovarian function can produce a more abrupt change. Yet a lower concentration does not automatically create symptoms, and many women with low measured levels do not have distressing low desire. Physiology is not the same thing as a treatment indication.

This distinction matters because hormone language easily slides from description into diagnosis. A woman naturally makes testosterone; that does not mean every symptom during menopause demonstrates testosterone deficiency. Treatment should begin with the problem she wants help with, not an assumption that every age-related hormonal change must be replaced.

A biological role does not prove a treatment benefit

Testosterone interacts with androgen receptors in multiple tissues. That biological reach makes it plausible that researchers would study effects on sexual function, mood, cognition, muscle and bone. Plausibility tells scientists what might be worth testing; it does not show that supplementation improves every function the hormone influences.

Clinical evidence asks a narrower question: in a defined group of people, does a particular formulation and exposure improve a patient-important outcome more than a comparison, with acceptable harms? A result in one domain cannot be automatically transferred to another. Sexual-desire evidence does not become brain-fog or muscle evidence by association.

The distinction also prevents high-dose reasoning. A physiological substance is not necessarily more beneficial at higher exposure. The therapeutic aim is meaningful symptom improvement while avoiding concentrations and physical signs associated with androgen excess, not pushing a hormone result towards the top of a chart.

What NICE actually recommends

NICE guideline NG23 says clinicians should consider testosterone supplementation for low sexual desire associated with menopause if HRT alone is not effective. The recommendation remains deliberately concise and specific. It is not a recommendation to add testosterone routinely to every menopause prescription.

NICE does not describe testosterone as an established treatment for fatigue, low mood, brain fog, weight control, muscle loss, osteoporosis prevention or dementia prevention. Those symptoms and concerns still deserve attention, but they require their own assessment rather than being folded into the evidence for sexual desire.

The wording “consider” also matters. It invites shared clinical judgement rather than automatic prescribing. The woman’s symptoms, distress, goals, HRT use, possible contributors, contraindications, expectations and capacity for safe monitoring all shape whether a trial is reasonable.

Low desire is common; distress changes the question

Some women feel content with less sexual interest after menopause and do not want treatment. Others experience a marked, persistent change that affects identity, intimacy or wellbeing. Treating both groups as though they have the same disorder would disregard autonomy and turn ordinary variation into a medical target.

Distress must also be understood rather than assumed. It may arise from the change itself, conflict with a partner’s expectations, painful sex, social pressure or fear that something is wrong. A sensitive consultation separates the woman’s priorities from ideas about how sexual a midlife woman ought to be.

Testosterone may be appropriate for selected postmenopausal women with HSDD, but it should not be used to enforce a relationship expectation or override reluctance caused by pain. Low libido deserves a clinical conversation, not a hormone score or a performance standard.

Why HRT and contributing symptoms are reviewed first

NICE places testosterone after HRT has not adequately helped low sexual desire associated with menopause. This sequence creates time to address vasomotor symptoms, sleep disruption and other menopause effects that may reduce interest indirectly. It also allows oestrogen treatment to be optimised where appropriate.

Genitourinary symptoms deserve particular attention. Vaginal dryness, tissue discomfort and pain during sex can understandably reduce desire. Local vaginal oestrogen or other suitable care may address that contributor more directly than testosterone, depending on assessment and individual suitability.

HRT is not the answer to every cause of low desire either. The point is to review the whole picture before adding another hormone. A woman can still have HSDD after contributory factors are addressed, and that is the context in which evidence for testosterone becomes most relevant.

Painful sex can look like low libido

Avoiding sex that hurts is protective behaviour, not evidence that someone lacks the right hormone. Genitourinary syndrome of menopause, vulval skin disease, infection, vulvodynia, pelvic-floor overactivity and other pelvic conditions can all contribute to discomfort. Each needs its own assessment and management.

Pain can also create anticipation, muscle guarding and anxiety even after the original tissue problem improves. A consultation should therefore ask about comfort, arousal, context and what happens before, during and after sexual activity. Testosterone should never be used to push through pain.

This is one reason a rapid online questionnaire is a poor substitute for women’s-health assessment. If a pathway records only “low libido”, it may miss the symptom that most needs treatment. Restoring comfort and safety can change desire without requiring testosterone at all.

Three questions, three different answers

What the strongest trial evidence supports

A 2019 systematic review and meta-analysis included 36 randomised controlled trials with 8,480 participants. In postmenopausal women, testosterone improved several sexual-function outcomes compared with placebo or another comparator, including desire and sexually satisfactory events, and reduced sexual distress. The average gains were meaningful but modest.

The review found roughly one additional satisfactory sexual event each month on average, alongside smaller improvements across desire, arousal, pleasure, orgasm and responsiveness measures. An average cannot predict an individual response. Some women benefit clearly, some notice little change and some stop because the balance is not worthwhile.

Non-oral routes had a more favourable lipid profile than oral testosterone in the review. Acne and hair growth were reported more often, while long-term safety and evidence for wellbeing, cognitive and musculoskeletal outcomes remained incomplete. That pattern supports targeted treatment, not universal supplementation.

Benefit is real, but it is not a wonder-drug effect

Sexual-desire trials often show a substantial response in placebo groups, reflecting expectation, attention, relationship change, symptom fluctuation and the value of discussing a neglected concern. A placebo response does not mean the problem is imaginary. It reminds us that medication is only one part of a complex outcome.

Treatment conversations should use realistic expectations. Improvement may involve more spontaneous interest, greater responsiveness, less distress or more satisfying sexual experiences rather than a dramatic transformation. The outcome that matters is the woman’s meaningful change, not whether a questionnaire score moves by any amount.

This is why testimonials can mislead even when sincere. A striking personal response cannot establish what caused every part of the change or what another woman should expect. Evidence gives a probability and boundary; individual follow-up determines whether a trial is helping.

The pivotal AndroFeme study was small

The MHRA assessment describes a double-blind, placebo-controlled crossover trial in 36 postmenopausal women with HSDD. Testosterone cream improved the study’s overall sexual-function score and selected domains, including desire and frequency. Thirty-three participants completed the study, so its size and design limit precision.

The assessment notes that the small trial alone was not robust enough to establish the full efficacy and safety case. Authorisation also relied on wider evidence from other transdermal testosterone products and the established relationship between systemic exposure and effect. Regulatory approval was therefore not based on one result in isolation.

Crucially, the trial did not show improvement in mood or energy over the study period. A product authorised for HSDD should not be marketed as though its licensing trial proved broader claims about motivation, cognition or vitality.

Licensed does not automatically mean routinely available

Marketing authorisation answers whether a product meets regulatory standards of quality, safety and efficacy for a defined indication. It does not settle NHS cost effectiveness, local formulary placement, supply arrangements, shared-care responsibilities or which clinician initiates and monitors treatment.

The 2026 BMS clinician tool acknowledges the new UK authorisation while noting that availability was linked to a pump presentation and was hoped for during 2026. This illustrates why regulatory status and practical access can move on different timelines. A licensed product may still be unfamiliar or unavailable locally.

The general NICE menopause recommendation is also not the same as a product-specific technology appraisal. Local services can interpret and operationalise national guidance differently. Patients experience the result as a postcode lottery even when every layer has a separate administrative explanation.

What the BBC Wales report reveals about access

BBC Wales reported variation between health-board pathways, including arrangements in which only specialists initiate treatment or primary care prescribes after specialist agreement. It also described increased referrals, waiting-list pressures and women receiving different answers after moving between neighbouring areas.

Those accounts should not be converted into a UK-wide prevalence estimate. They document reported experiences and professional observations in Wales at a particular time. They do, however, expose how unclear responsibility, off-label history, cost differences and limited clinician confidence can become practical barriers.

The report also included women who felt helped and one who chose an online male pathway after previously receiving monitored care. Their experiences explain the pressure without validating the workaround. Access inequality is real; so is the danger of giving false information to a prescriber who needs an accurate history.

Why women may go around the system

A woman who has been refused, moved area, waited months for specialist review or faced repeated private costs may feel that an online route is the only practical option. Social-media testimony can make the choice seem ordinary, especially when the treatment itself is supported for some women.

Moralising misses the system failure. Yet empathy cannot make an unsafe pathway safe. Presenting as male can remove the indication assessment, pregnancy discussion, female reference range, review of pain and HRT, appropriate exposure, side-effect surveillance and follow-up that distinguish treatment from self-medication.

A better response is consistent, knowledgeable access with honest limits. Services should be able to explain who may benefit, what remains unproven, how monitoring works and where to refer when primary-care expertise is insufficient. Women should not have to choose between dismissal and improvisation.

A blood test cannot diagnose low desire

The MHRA assessment states that no definitive circulating testosterone concentration separates women with sexual dysfunction from those without it. Blood concentrations do not directly represent tissue exposure or sensitivity, and female measurements can be technically challenging at low levels.

A result below a laboratory reference limit does not prove that testosterone will improve desire. A result within range does not invalidate distress or exclude HSDD. Diagnosis depends on symptoms, persistence, context, distress and alternative explanations rather than a biochemical threshold.

This is a vital correction to “optimisation” culture. Desire cannot be reduced to a laboratory ranking. Testing can support safer prescribing, but it cannot tell a woman how much desire she ought to have or whether a relationship concern is hormonal.

So why are testosterone levels measured?

A baseline total testosterone measurement helps identify an unexpectedly high starting concentration and creates a reference for follow-up. During treatment, repeat measurement helps detect supraphysiological exposure that may increase androgenic adverse effects. It is mainly a safety boundary rather than an efficacy target.

Clinical response remains central. The prescriber asks whether the distressing low desire has meaningfully improved and whether acne, excess hair growth, scalp-hair change or other concerns have developed. A reassuring number cannot substitute for benefit, and symptom improvement does not justify an excessive number.

Laboratory methods and reference ranges vary, so publishing one universal target would be misleading. Current BMS guidance favours total testosterone interpreted against the female range of the laboratory performing the test, supported by clinical review.

The common androgenic effects are usually manageable

The MHRA assessment identifies acne and increased hair growth as the most common treatment-related adverse effects with AndroFeme. The 2026 BMS tool also lists excess hair growth, acne and weight gain, describing these effects as usually reversible when exposure is reduced or treatment is stopped.

These effects are related to dose and serum concentration. They are not evidence that testosterone inevitably “masculinises” women, and severe virilisation was not seen in the AndroFeme clinical studies reviewed by MHRA. Proportionate language matters because fear can deny appropriate treatment just as hype can encourage excess.

New androgenic symptoms still deserve review. The answer is not to accept them as the price of treatment or to self-adjust from internet advice. Side effects help clinicians judge exposure and whether the benefit-risk balance remains appropriate.

Supraphysiological exposure is a different risk conversation

At markedly high or prolonged exposure, androgenic changes can become more pronounced. Specialist guidance warns about scalp-hair loss, voice deepening and clitoral enlargement as potential consequences of excessive dosing. These are not expected outcomes of properly monitored physiological treatment.

Some changes may not fully reverse, particularly voice change or clitoral enlargement after substantial androgen exposure. Evidence is limited and the risk depends on exposure and duration, so categorical promises about reversibility are unsafe. Early recognition and clinical review are important.

The AndroFeme studies assessed by MHRA reported no voice changes or other virilising signs. That reassuring observation should remain alongside, not erase, the broader warning about misuse. Licensed female treatment and persistent male-range exposure should not be discussed as though they carry identical risks.

Pregnancy and breastfeeding require explicit discussion

Current specialist guidance advises avoiding testosterone during pregnancy and breastfeeding. Testosterone is not contraception, and a woman who could become pregnant needs an individual discussion about reproductive plans and reliable contraception before treatment.

Androgen exposure may harm a developing fetus. A prescriber also needs to know about fertility treatment, menstrual status and any possibility of pregnancy rather than assuming that menopause symptoms make pregnancy impossible. Product-specific advice should guide action if pregnancy occurs.

This is another safety element lost when someone presents as male to obtain treatment. An accurate sex and reproductive history is clinically relevant, not bureaucratic gatekeeping. Personal advice belongs with the prescriber because circumstances and product information can change.

What is known about cardiovascular safety

Short-term randomised evidence for non-oral testosterone used near female physiological concentrations has not shown major adverse cardiometabolic effects. The 2019 meta-analysis found unfavourable lipid changes with oral, but not non-oral, testosterone. That supports route-specific rather than blanket safety statements.

Long-term cardiovascular evidence remains limited, and trial populations may not represent women with higher baseline cardiovascular risk. The MHRA assessment explicitly identifies the need for longer-term data. Absence of a short-term signal is not proof of lifetime safety.

Nor does uncertainty prove harm. Regulatory approval means the known benefit-risk balance was judged favourable for the authorised group and conditions of use. Ongoing review should consider a woman’s health history, changes over time and emerging evidence.

Energy, brain fog, mood and motivation

Some women report greater energy, clarity, confidence or wellbeing after starting testosterone. Their experiences deserve to be heard. They do not establish that testosterone specifically treats fatigue, cognitive symptoms, depression or reduced motivation, because several symptoms and treatments may change together.

The 2026 BMS clinician tool says randomised trials have not demonstrated benefits for cognition, mood, energy or musculoskeletal health. The AndroFeme pivotal study likewise found no change in mood or energy over its study period. Current evidence therefore does not support prescribing for these outcomes alone.

Anecdote and evidence can coexist without either being mocked. A personal improvement may be real while its mechanism remains uncertain. Public communication should say what has been shown, what has not and what current research is trying to answer.

Muscle, bone and “brain protection” claims

Testosterone has anabolic effects at higher exposures in other populations, but that does not make female physiological supplementation an established treatment for sarcopenia or a substitute for resistance exercise, nutrition and assessment of other causes of weakness.

Current BMS statements do not support testosterone to prevent bone loss or dementia. The 2019 trial meta-analysis found no effect on body composition, musculoskeletal variables or cognitive measures, although fewer participants contributed data to those outcomes. Insufficient evidence is not the same as a proven absence of any effect.

Preventive claims are especially consequential because they encourage long-term use in people without the evidence-based indication. Bone, memory and mood concerns deserve evidence-based assessment in their own right rather than an anti-ageing promise attached to one hormone.

How long a therapeutic trial should be judged

The 2026 BMS tool says it may take three to six months to evaluate efficacy fully. That does not guarantee delayed benefit, and it is not a reason to continue indefinitely without meaningful improvement. Review should assess the woman’s original treatment goal rather than a vague sense of optimisation.

If distressing low desire has not improved after an appropriate monitored trial, the indication for continuing should be reconsidered. Side effects, exposure, adherence, HRT, pain and other contributors may need review. Stopping for lack of benefit is evidence-led care, not a failure by the patient.

Women who benefit still need periodic re-evaluation. Symptoms, relationships, health risks and preferences change. Ongoing prescribing should remain a shared decision with continued monitoring rather than becoming an automatic lifetime repeat.

What good monitoring looks like

Good care begins with a clinical assessment of desire, distress, HRT, comfort, medicines, mental health, relationships, reproductive context and expectations. A baseline total testosterone measurement supports safety. The prescriber explains common effects, transfer precautions and what should prompt review.

Follow-up considers symptom response and androgenic signs alongside a repeat total testosterone level. Current BMS guidance recognises early testing after initiation and continued monitoring every six to twelve months, with timing adapted to clinical services and product use. This article does not replace an individual schedule.

Monitoring is not simply collecting numbers. It checks that the right symptom is improving without excessive exposure and creates a place to revisit alternatives. If the process cannot provide assessment and follow-up, it is not equivalent to a women’s-health prescribing pathway.

The WHC decision framework

First define the problem. Is the main concern persistent, distressing low sexual desire, or is the request primarily about tiredness, concentration, weight, strength or ageing? Those concerns are valid, but the evidence and clinical route differ.

Next review contributors and current care. Pain, GSM, medication, mood, sleep, relationship factors and HRT may need attention. Then consider whether testosterone matches the evidence-based indication and whether the chosen product can be prescribed at female physiological exposure with reliable follow-up.

Finally define success and boundaries before treatment begins. The plan should identify the symptom being assessed, how side effects and testosterone levels will be reviewed, and when a lack of meaningful benefit will lead to reconsideration. More testosterone is not more treatment.

Five claims the evidence does not support

“All menopausal women are testosterone deficient” is not supported. “A low blood result proves treatment is needed” is also wrong because no diagnostic threshold separates women with and without HSDD. Both claims turn context-dependent care into a number.

“Testosterone is proven to fix brain fog and energy” runs ahead of current trial evidence. “If some helps, more must work better” ignores concentration-related androgenic effects. Neither claim belongs in responsible menopause prescribing.

“There is still no testosterone licensed for women in Britain” became outdated after the 2025 authorisation of AndroFeme. The more accurate statement is that licensing, product availability, NICE processes and local NHS adoption are different stages, so access may remain uneven.